Volume 19, Issue 1, Summer 2022, Page 1-160

Synthetic Cannabinoid Receptor Agonist ‘JWH-018’ does not mimic Serotonin

Adam J. Pottsa; Israa M. Albanaa; Sarah E. Gartsidec; Peter S. Hansonb; Simon L. Hilld; Simon H. Thomasb; Sarah J. Judgec

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 1-7
DOI: 10.33899/iphr.2022.174794

Synthetic cannabinoid receptor agonists (SCRAs) are popular recreational drugs. It has been suggested that indole-containing SCRAs may have activity at several serotonergic targets, owing to their structural similarity to the neurotransmitter serotonin (5-HT). This similarity may be responsible for features of toxicity similar to serotonin syndrome observed in cases of SCRA intoxication. To determine whether indole-SCRAs have activity at serotonergic targets we investigated the effect of JWH-018, an indole-containing SCRA, with a non-indole-containing SCRA (CP55,940) and an endocannabinoid (anandamide) on 5-HT neuronal functions in rat brain slices; 5-HT neuronal activity was examined using in vitro extracellular single-unit electrophysiology in the dorsal raphe nucleus and 5-HT presynaptic uptake was examined using radiolabeled 5-HT(3[H] 5-HT) in the hippocampus. 5-HT (50µM) inhibited the 5-HT neuronal firing rate but JWH-018 (50µM) had no effect on the basal or NMDA (30µM) augmented firing rate. In contrast, anandamide (10uM) increased the NMDA-augmented firing rate of 5-HT neurons, but not the basal rate. The selective serotonin reuptake inhibitor fluoxetine (0.001 – 10 µM) inhibited 5-HT reuptake but JWH-018 (0.001 – 10 µM) had no effect on serotonin uptake. Our data suggest that indole-SCRAs and non-indole SCRAs do not directly interact with serotonergic targets in either the dorsal raphe nucleus or hippocampus. Further mechanistic studies are needed to determine if SCRAs affect serotonergic neurotransmission through modulation of afferents to 5-HT neurons.

Synthesis, mechanism of action, and structure-activity relationships of 1,3-oxazolidinones as anti-bacterial Agent: A review

Ali M. Hantosh; Nawal A. Rajab2; Faris T. Abachi

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 8-16
DOI: 10.33899/iphr.2022.174796

Background: 1,3-oxazolidinones are an important class of antibiotics that are recognized with higher activities against Gram-positive bacteria. linezolid, tedizolid phosphate, and radezolid are important examples of this group. Aim: The aim of this review is to study the effect of 1,3-oxazolidinone derivatives as Gram-positive antibacterial agents. Results: There are many methods for preparing the oxazolidinone derivatives. Many patents Three new antibacterial oxazolidinones are linezolid, tedizolid phosphate, and radezolid. They differ in the side chain according to their structure-activity relationship. Conclusion: Study the structure-activity relationship (SAR) of oxazolidinone derivatives as new antibacterial agents. 

Evaluation of serum lipid profile in breast cancer patients: a case control study

Shahbaa A. Al-bayati

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 17-22
DOI: 10.33899/iphr.2022.174797

Objective: This study was conducted to investigate the relationship between serum lipid profile and breast cancer disease.
Patients and methods: One hundred breast cancer women and 75 women with benign breast mass as a control group were included in the study. The control and the patient groups were aged matched. The age range of the control group was between 25 to 70 years (mean ± SD: 50.4 ± 15.1 years). The age range of the patient group was between 25 to 71 yeas (mean ± SD: 49.1 ± 14.6 years). The patients were undergone radical modified mastectomy, then treated with chemotherapy and radiotherapy after the operation. Five mL of blood samples from the patient and control groups were taken, and the patient samples were taken before the operation. The blood samples were analyzed for serum lipid profile. The patients and the control groups were advised to fast for 14 hours before taking the blood samples. Body mass index was measured for the patients and controls. The stage, lymph involvement, and metastasis of the cancer were also included.
Results: Body mass index (BMI) in patients was significantly higher than controls. However, serum total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C) and atherogenic index (AI), in the patients were significantly lower than controls. High-density lipoprotein cholesterol (HLD-C) was higher in the patients compared with the controls but not significant.
Conclusion: a significant decrease in TC, TGs, and LDL-C with no significant increase for HDL-C was noticed in breast cancer women. Serum lipid profile may not be considered as a risk factor for breast cancer.

The Efficacy of Azelaic Acid 20% Cream in the Treatment of Scalp Alopecia Areata

Mudheher I. Salih; Dindar S. Qurtas

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 23-33
DOI: 10.33899/iphr.2022.174798

Introduction: Alopecia areata is a common, inflammatory, non-scarring type of hair loss that affects persons of both sexes and all age groups, with prevalence in the general population of approximately 0.1–0.2%. It is characterized by variable clinical presentations, ranging from single or multiple well-circumscribed patches of hair loss to extensive involvement with complete absence of body and scalp hair. Alopecia areata is an autoimmune disease of the hair follicle. Its pathogenesis is associated with loss of follicular immune privilege and T-cell mediated inflammatory response, leading to interruption of the hair growth cycle. The diagnosis of alopecia areata is usually based on clinical manifestations in addition to using   severity of alopecia tool score. Currently, there is no treatment for alopecia areata approved by the US Food and Drugs Administration. However, several treatment modalities for alopecia areata have been introduced with variable outcomes. Although topical and systemic immunomodulators are the mainstay options, there is still a lack of high-quality randomized controlled trials supporting these treatment modalities.  Topical Corticosteroids are considered the first-line therapy for patch-type alopecia areata. Azelaic acid is a dicarboxylic acid, derived from the fungus Pityrosporum ovale and is regarded as an effective topical therapy for patchy alopecia areata. Aim of study: The present study aims to measure the efficacy of topical azelaic acid cream 20% in the treatment of alopecia areata. Patients and Methods: The all 30 patients were collected from Erbil Dermatology Teaching Center. They were divided into two groups: group A includes fifteen   patients on topical clobetasol propionate 0.05% cream; group B includes fifteen patients on topical azelaic acid 20% cream. Both treatment groups were followed up for period of around twelve weeks with monthly check up visits. Both drugs were applied topically once daily at night. Results: the comparison between the baseline and 12 weeks visits for each study group concerning severity of alopecia tool score shows that the mean of the score for both groups at 12 weeks visit is lower than that of baseline visit in a statistically significant way (group A, p=0.007, group B, p=0.036). Conclusions: This study showed that topical azelaic acid cream 20% has an acceptable efficacy in comparison to topical clobetasol ointment 0.05% in the treatment of localized alopecia areata of scalp and can be considered as a therapeutic option for this condition.

Prevalence of Non-Scarring Alopecia among Female Patients Complaining from Hirsutism

Salar O. Awrahman; Dindar S. Qurtas

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 34-46
DOI: 10.33899/iphr.2022.174799

Background: Hirsutism is a common clinical problem that cause great distress to the patient, and which true incidence is unknown. However, it is more common among Mediterranean women. Hirsutism is excessive terminal hair growth in women in androgen-dependent. Often the cause of it is hyperandrogenism but it can be also idiopathic. In hyperandrogenic states like in cases of PCOS, it can associate with other cutaneous clinical signs of this endocrine disorder like acne and AGA.
Aim of the study: To evaluate the prevalence of non-scaring hair loss (alopecia) among female patients complaining of hirsutism.
Patients and Methods: Cross-sectional study was conducted on more than 90 patients who have hirsutism within reproductive age (married and UN married) and complained of hair loss A special questionnaire design was developed to record all their data. Hair loss was diagnosed and assessed by visual overview examination by the naked eye and trichoscopic examination, by using Dermatoscope Foto finder stationary mode. The photo of the trichoscopic examination was saved and the features of each type of non-scaring alopecia were assessed.
Results: In our study, there are three types of non-scaring hair loss associated with hirsutism (Androgenetic alopecia, telogen effluvium, androgenic alopecia with telogen effluvium). The most common type of hair loss associated with hirsutism is (Androgenetic alopecia with telogen effluvium) 55.6%. The most common trichoscopic features found in (Androgenetic alopecia with telogen effluvium) hair shaft heterogeneity 100%, HF with only one hair 74%, peripilar sign 82%, empty hair follicle 96%, up right re-growing hair 92% and black dots 36%, while these findings present in a lesser ratio in other groups.
Conclusions: Androgenetic alopecia with telogen effluvium most common non-scarring alopecia associated with hirsutism.

Evaluation of serum zinc level in patients with Alopecia Areata

Ivan Abdullah; Sangar Othman

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 47-53
DOI: 10.33899/iphr.2022.174800

Background: Alopecia areata (AA) is non-scarring telogenic alopecia of autoimmune etiology. Clinically, the disease is characterized by the appearance of alopecic patches or plaques of varying size and number on the scalp with peak incidence 2% in the general population, can involve any age group with higher prevalence in younger patients.
Aim: The purpose of this study is to estimate serum zinc level in patient with alopecia areata comparing to age, sex match healthy controls.
Method: A case-control study was conducted on total number of 120 subjects;60 patients with AA and 60 age- and sex matched healthy controls. Serum zinc levels were assessed in all subjects. Comparison of mean serum zinc levels was done between all patients and controls. A significantly lower serum zinc level was found in patients with AA compared with controls and the significant inverse correlations existed between serum zinc level and severity of AA.

Intradermal injection of tranexamic acid combined with topical hydroquinone cream versus topical hydroquinone cream alone in the treatment of melasma

Lavan Y. Taha; Pers Y. Sheer

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 54-64
DOI: 10.33899/iphr.2022.174801

Background: Melasma is a common acquired skin disorder that presents as a bilateral, blotchy, brownish facial pigmentation due to a dysfunction in melanogenesis. It is most common in people who tans easily or have naturally brown skin (Fitzpatrick’s skin phototypes III, IV). Although several treatments are currently used, it remains a great challenge.
Aim: This study aims to compare the efficacy of intradermal injection of tranexamic acid (TA) combined with topical hydroquinone cream versus hydroquinone (HQ) cream in the treatment of melasma.
Materials and Methods: In thisinterventional prospective comparative clinical trial study, 31 patients with facial melasma were divided randomly into 2 groups, A (16 patients) and B (15 patients). Group A received the combination treatment of intralesional tranexamic acid and topical hydroquinone cream, while group B received topical hydroquinone cream alone. Both groups were assessed by MASI score at baseline and weeks 2, 4, 6, and 8.
Results: Thirty-one patients (16 in group A and 15 in group B) completed the study. According to the decline in MASI score, the combination of tranexamic acid and hydroquinone was more effective than hydroquinone alone in the treatment of melasma.
Conclusion: Injection of TA intradermally combined with topical HQ cream can be an effective treatment for melasma.

Topical Imiquimod 5% Cream Versus Salicylic acid 30% Cream in Treating Common Warts: A comparative study

Dilpak N. Muhammed-Ameen; Alan D. Meran

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 65-79
DOI: 10.33899/iphr.2022.174802

Background: Warts are considered the foremost common infectious diseases affecting the epidermal keratinocytes, the causative agent is the human papilloma virus (HPV). Diagnosis usually can be confirmed depending on both the clinical features and family history. Although these viruses create no acute signs or symptoms, they induce slow growth of lesions that can remain for a long period.
Aim: This study aims to assess the efficacy of topical imiquimod 5% cream in treating cutaneous warts and compare it with the effects of salicylic acid on cutaneous warts.
Method: In this study a total of 68 patients were allocated randomly into two groups; one group treated with Imiquimod cream 5% (n=35) and the other group treated with salicylic acid 30% cream (n=33) to evaluate the difference between these two groups. The response to treatment is evaluated through pictures of the lesions taken before, during, and after treatment.
Conclusion: Both topical imiquimod 5% cream and salicylic acid 30% cream can be used safely for the treatment of common warts. Topical salicylic acid cream 30% may show better efficacy but also has more risk of irritation.

Drug-Induced Nephrotoxicity: A Review

Muthanna T. Khalaf; Zeina A. Althanoon

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 80-89
DOI: 10.33899/iphr.2022.174803

Background: Nephrotoxicity is referred to as rapid degeneration in kidney functioning due to the toxic effects of medications. The glomerulus and proximal renal tubule are the fundamental portions of the nephron to be affected by drugs leading to nephrotoxicity. Prescribed medications like antibiotics (aminoglycoside, and vancomycin), amphotericin B, antidepressants (amitriptyline, fluoxetine), acyclovir, angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, non-steroidal anti-inflammatory drugs, cocaine, statins, antihistamines (Diphenhydramine), and sulfonamides can result in specific outcomes relative to nephrotoxicity, such as renal injury, inflammation, platelet aggregation, cell cytotoxicity, thrombosis, reduced renal blood flow, and crystal precipitation result in nephrotoxicity.
Objective: we aimed to review the various pathogenic mechanisms responsible for drug-induced nephrotoxicity including, altered intra-glomerular hemodynamics, tubular cell toxicity, renal inflammation, crystal nephropathy, rhabdomyolysis, and thrombotic microangiopathy. The review also highlights risk factors related to the patient and the drugs being prescribed. The majority of the nephrotoxicity risk factors depend on the patients' age, gender, pre-existing renal insufficiency, drug dosage, and hypersensitivity to drug toxicity.
Methods: We have searched the different databases to recruit published material mainly focusing on Pubmed, GoogleScholars, and Iraqi Virtual Science Library.
Conclusion: To sum up, the review explains the necessity of evaluating nephrotoxicity, drug dosage, and risk factors as primary preventive measures to avoid drug-induced Nephrotoxicity.

Sleep Quality in Diabetic Patients

Israa M. Salih; Harith K. Al-Qazaz

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 90-97
DOI: 10.33899/iphr.2022.174804

Background: Diabetes mellitus (DM) is a metabolic condition characterized by a persistent rise in blood glucose and a disturbance in the body metabolic state. Sleep is essential for survival and the proper functioning of the body. In diabetes, appropriate sleep is important for handling insulin levels, preventing the build-up of inflammatory cytokines and maintaining body caloric intake.
Objective: This review was conducted to focus on currently available information on sleep changes in diabetic patients.
Methods: An extensive search was conducted on websites, including PubMed, MEDLINE, and Google Scholar, to identify studies that examine the link between sleep quality in patients with type 2 diabetes from 2012 to 2022. Electronic database searches revealed a total number of 24 out of 87 articles that fulfilled the aforementioned criteria for review.
Conclusion: Patients with impaired glucose tolerance have poorer sleep performance which is linked to cognitive impairment. It's well worth looking into if sleep optimization can help those sufferers improve their overall cognitive performance. Support and taking care of patients with diabetes and cognitive impairment is going properly past clinical remedy.

Role of Neurotropic B Vitamins in the Treatment of Diabetic Neuropathy: Narrative Review

Narmin S. Essa; Mohammed I. Aladul

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 98-111
DOI: 10.33899/iphr.2022.174805

Diabetic neuropathy (DN) is the presence of signs and symptoms that are suggestive of neuropathy in diabetic patients, after excluding other possible causes of nerve damage. Diabetic neuropathy and its complications affect the quality of life, sleep patterns, and daily activities of the patient. Up to date no FDA-approved reversing treatment was found. Studies showed that neurotropic B vitamins (vitamin B1, B6 and B12) had an important role in nerve regeneration and included in prescriptions of DN. However, these vitamins were not included in the guidelines of DN management. The aim of this review is to explore the role of neurotropic B vitamins in the treatment of DN including the mechanism of action and the evidence supporting their use. Review of the literature revealed many clinical trials examining the effect of these vitamins (alone or combined) for DN. These vitamins and/or their derivatives had well-illustrated disease-modifying mechanisms on DN. However, larger randomized clinical trials for longer periods are needed to approve their use in DN and to be included in national and international guidelines. This was hindered by the fact that vitamins are non-patentable and therefore fewer funds would be allocated for large randomized clinical trials. 

Health-related quality of life among patients with osteoarthritis: A review of literature

Zahraa S. Thabit; Harith K. Al-Qazaz

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 112-124
DOI: 10.33899/iphr.2022.174806

Background and objective: Osteoarthritis (OA) is a more common disease that effects the joints in the world and it is more prevalent with increasing age, and is most common in old people. Quality of life (QoL) is defined as a set of values and culture that is aligned with an individual's aim and in accordance with their expectations, living standards, and hobbies. This work aimed to review the literature measured on QoL and the relationship of its variables with osteoarthritis.
Method: These articles are introduce depending on random electronic research that take place in certain databases like MEDLINE, EMBASE, and Cochrane. Only published works for the last twelve years between 2010 and 2022 years were included.
Result: Only 20 published works were included after abstract screening. The OA is one of the chronic diseases that affect QoL in term of disability, loss of physical activity, impair daily activity, and loss of social life. The WHOQOL and WHOQOL-BRIF are more appropriate to detect the QoL. The body mass index is one of the importance indices related to the patients with osteoarthritis.
Conclusion: OA is affecting the QoL and common in elderly female. They are many scales for detect the QoL, they are either related to the global QoL as in WHOQOL and WHOQOL-BRIF or to the health QoL. The global scales are more significant and valid in dealing with QoL in chronic disease.

Anticancer Induced Nephrotoxicity: A Review

Akram A. Hammo; Zeina A. Althanoon; Abdulla A. Ahmad

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 125-133
DOI: 10.33899/iphr.2022.174807

Introduction: Drug-induced adverse effects are the major challenging issue in the clinical setting of chemotherapy. Kidneys are responsible for the elimination of many chemotherapeutic agents which makes them a common target for adverse effects. Nephrotoxicity is a deleterious adverse effect carrying a great negative impact on body homeostasis and maintenance of cellular functions.
Aim: The present review aims to focus on anticancer-induced nephrotoxicity including the causes and mechanisms of toxicity.
Methods: Different databases of published materials are recruited mainly from PubMed, Google Scholars, and Iraqi Virtual Science Library.
Results: The review shows that the recurrent use of many anticancer drugs can cause different types of kidney damage via different mechanisms.
Conclusion: Anticancer-induced nephrotoxicity is a crucial problem which needs more research to clarify the mechanisms of kidney damage and the methods to prevent them. Maintaining appropriate and enough hydration, electrolyte replacement, and avoiding concomitant medications are useful steps in overcoming the nephrotoxicity.

Effects Of Estrogen and Progesterone Used in Oral Contraceptive Pills: A review

Farah R. Noori; Zeina A. Althanoon

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 134-146
DOI: 10.33899/iphr.2022.174808

Introduction Contraception is a method of avoiding unplanned pregnancy. Combined oral contraceptives (COCs) have become a prominent birth control method due to their contraceptive efficacy and acceptability profile. The use of oral contraceptive pills (OCPs) is linked to several health advantages as well as problems. Oral contraceptive pills can alter carbohydrate and lipid metabolism, including increased in blood glucose, triglyceride, low density lipoprotein LDL and total cholesterol. However, these changes may be affected by modification in type of progesterone used in oral contraceptive formulation.
Objective: the aim of this study is to evaluate the effect of oral contraceptives on glucose levels and lipid profile by emphasizing many studies that show the effect of oral contraceptive pills on the metabolic parameters such as (Fasting serum glucose, HbA1c%, total cholesterol, LDL, HDL and triglyceride level).

A Review in the View on Wounds

Zahraa S. Qasim

Iraqi Journal of Pharmacy, 2022, Volume 19, Issue 1, Pages 147-158
DOI: 10.33899/iphr.2022.174809

Whatever the etiology of wounds, some heal without difficulties, however in chronic wound the ultimate goal in wounds healing are to control symptoms and prevent complication like infection. The latter occurs when microorganisms of different kinds grow within damaged skin. The sign and symptoms vary according to wounds type, severity of infection and immune system, generally simple wound infection can be treated at home. However medical attention should be needed in severe wounds infection. Clinical and laboratory examination play an important role in diagnosis wounds infection. Different kinds of wounds managements are required as antibiotics, antiseptics, depressing and debridement. Hemostasis, inflammation, proliferation, and remodeling are the main four stages involves in wounds healing.
The aims of this review are highlight the types of wounds, the microorganisms involved, causes and management, and the effective preventive procedures of wound infection.